Betsy Bates

VANCOUVER, B.C. — If physicians had a better understanding of the bacteriology of chronic wounds, they would stop overprescribing antibiotics for this indication—a strategy that rarely works and contributes to antibiotic resistance.

That's the assessment of Brian Kunimoto, M.D., director of the Wound Healing Clinic at the Vancouver Hospital and Health Sciences Centre and a member of the dermatology faculty at the University of British Columbia in Vancouver.

“Is there a problem with bacteria that grow in wounds, convincing some of us to do silly things like order useless tests, and worse yet, actually act on such useless information … [by] prescribing drugs that have no chance of working? I think it's a big problem, and it has nasty consequences,” said Dr. Kunimoto at the annual meeting of the Pacific Dermatologic Association.

Wounds come in many forms, with bacteria acting as attackers that have more or less of an impact depending on the vulnerability of the host as well as their own numbers and virulence, he said. (See chart.)

When bacteria are planktonic, they live an independent, nomadic life, disorganized and generally in a fluid state. In this form, they pose little threat to a human host.

However, when they begin to unite in an organized, adherent, cooperative “city-state,” they form a biofilm that poses a considerable challenge to physicians, Dr. Kunimoto said. Approximately 65% of all bacterial skin infections are related to biofilms characterized by their creamy, adherent properties.

“You brush off a biofilm every night when you brush your teeth. The classic biofilm is plaque on your teeth,” he said.

Biofilms, he explained, are made up of an exopolysaccharide matrix that allows for intracellular communication, production of a food supply, an escape route for waste, and most troubling, the sharing of genetic information.

A biofilm is polymicrobial, allowing for a harmonious existence of many forms of bacteria.

“I think bacteria do a better job at multiculturalism than our country, Canada,” he mused.

Culturing a biofilm is useless, he maintained. “It's no different from culturing your nose. You will find—wow!—bacteria! It gives us no really useful information.”

A culture may identify some bacteria present in the biofilm, but it will not characterize the rich and diverse population flourishing in a wound.

Moreover, neither topical nor systemic antibiotics penetrate a biofilm effectively, so they will be impotent, or worse, will provide highly useful resistance information to bacteria essentially sharing a bulletin board in a bustling city.

The best clinical practice for attacking biofilms is relentless debridement, according to Dr. Kunimoto.

“As I say to the residents in the clinic, 'Don't slough sloughing the slough.'

“Don't throw an antibiotic at this. Get out your tools and dig away. Don't give up,” he said.

Several antimicrobial agents can be used as adjuncts, including silver, starch iodine, and even manuka honey.

But the most critical treatment is repeated debridement, performed, if necessary, after a lengthy (2–3 hour) application of a topical anesthetic such as EMLA, he said.

Antibiotics are of use only in true clinical infections.

Nitric Oxide Gas Wards Off Bacteria

In the frustrating war against chronic wounds, Brian Kunimoto, M.D., and associates at the University of British Columbia think they may have found a secret weapon that comes in a tank.

It's nitric oxide gas.

A naturally produced, lipophilic molecule, nitric oxide, unlike antibiotics, easily penetrates biofilms, well-organized populations of bacteria that can form in chronic, difficult-to-heal wounds.

“I call it a smoking gun,” said Dr. Kunimoto, director of the Wound Healing Clinic at Vancouver Hospital and Health Sciences Centre.

He explained that nitric oxide combines with reactive oxygen to create “an entire soup of bacteriocidal intermediates” in a wound, and poisons the iron enzyme aconitase.

In the presence of this onslaught, “unless a bacterium can quickly develop into an anaerobic organism, it will die,” he said at the annual meeting of the Pacific Dermatologic Association.

Nitric oxide also deaminates DNA and enhances the damaging effects of hydrogen peroxide when it is present as a reactive oxygen intermediate.

Studies at the University of British Columbia found that counts of bacteria, including Staphylococcus aureus, pseudomonas, and methicillin-resistant S. aureus, plummeted to zero within hours of exposure to gaseous nitric oxide.

Home therapy involving nighttime exposure to the gas quickly healed a 2-year-old, nonhealing ankle ulcer in a 55-year-old man with severe venous disease, said Dr. Kunimoto, who recently published the case (J. Cutan. Med. Surg. 2004;8:233–9).

“This is remarkable for this gentleman, [considering] we worked on him for 2 years and got nowhere,” he said. “We've shifted the balance in favor of the host.”

The Canadian government has recently approved funding for a large study of nitric oxide gas to see if the results can be duplicated in other nonhealing wounds.

How to Identify Wound Types

Contamination

▸ Example: Fall from a bike, abraded skin.

▸ Bacteria: “Just passing through.”

▸ Signs and symptoms: None.

▸ Healing: Not compromised.

▸ Testing: None necessary.

▸ Treatment: Cleansing with normal saline.

Simple Colonization

▸ Example: Wound of a few days' duration.

▸ Bacteria: Living in the wound, but planktonic and disorganized.

▸ Signs and symptoms: None of note.

▸ Healing: Not compromised.

▸ Testing: None required.

▸ Treatment: Cleansing with normal saline.

Complicated Colonization (Biofilm)

▸ Example: Chronic wound.

▸ Bacteria: Significant in numbers and virulence. Well organized, often as a “biofilm.”

▸ Signs and symptoms: New onset of wound pain and wound-bed deterioration (granulation tissue loss, friability of granulation tissue).

▸ Healing: Compromised.

▸ Testing: None required.

▸ Treatment: Aggressive debridement, possibly with adjunctive antimicrobial measures (such as manuka honey or starch iodine).

Clinical Infection (Rare)

▸ Example: Markedly worsening chronic wound.

▸ Bacteria: Very significant in numbers and virulence.

▸ Signs and symptoms: Significant in numbers and virulence. Well organized, often as “biofilm.” There is evidence of a host inflammatory response (cellulitis) and possible systemic toxicity (fever and malaise).

▸ Healing: Compromised.

▸ Testing: Wound biopsy of base preferable to culture.

▸ Treatment: Systemic antibiotics.

Source: Dr. Kunimoto

VANCOUVER, B.C. — If physicians had a better understanding of the bacteriology of chronic wounds, they would stop overprescribing antibiotics for this indication—a strategy that rarely works and contributes to antibiotic resistance.

That's the assessment of Brian Kunimoto, M.D., director of the Wound Healing Clinic at the Vancouver Hospital and Health Sciences Centre and a member of the dermatology faculty at the University of British Columbia in Vancouver.

“Is there a problem with bacteria that grow in wounds, convincing some of us to do silly things like order useless tests, and worse yet, actually act on such useless information … [by] prescribing drugs that have no chance of working? I think it's a big problem, and it has nasty consequences,” said Dr. Kunimoto at the annual meeting of the Pacific Dermatologic Association.

Wounds come in many forms, with bacteria acting as attackers that have more or less of an impact depending on the vulnerability of the host as well as their own numbers and virulence, he said. (See chart.)

When bacteria are planktonic, they live an independent, nomadic life, disorganized and generally in a fluid state. In this form, they pose little threat to a human host.

However, when they begin to unite in an organized, adherent, cooperative “city-state,” they form a biofilm that poses a considerable challenge to physicians, Dr. Kunimoto said. Approximately 65% of all bacterial skin infections are related to biofilms characterized by their creamy, adherent properties.

“You brush off a biofilm every night when you brush your teeth. The classic biofilm is plaque on your teeth,” he said.

Biofilms, he explained, are made up of an exopolysaccharide matrix that allows for intracellular communication, production of a food supply, an escape route for waste, and most troubling, the sharing of genetic information.

A biofilm is polymicrobial, allowing for a harmonious existence of many forms of bacteria.

“I think bacteria do a better job at multiculturalism than our country, Canada,” he mused.

Culturing a biofilm is useless, he maintained. “It's no different from culturing your nose. You will find—wow!—bacteria! It gives us no really useful information.”

A culture may identify some bacteria present in the biofilm, but it will not characterize the rich and diverse population flourishing in a wound.

Moreover, neither topical nor systemic antibiotics penetrate a biofilm effectively, so they will be impotent, or worse, will provide highly useful resistance information to bacteria essentially sharing a bulletin board in a bustling city.

The best clinical practice for attacking biofilms is relentless debridement, according to Dr. Kunimoto.

“As I say to the residents in the clinic, 'Don't slough sloughing the slough.'

“Don't throw an antibiotic at this. Get out your tools and dig away. Don't give up,” he said.

Several antimicrobial agents can be used as adjuncts, including silver, starch iodine, and even manuka honey.

But the most critical treatment is repeated debridement, performed, if necessary, after a lengthy (2–3 hour) application of a topical anesthetic such as EMLA, he said.

Antibiotics are of use only in true clinical infections.

Nitric Oxide Gas Wards Off Bacteria

In the frustrating war against chronic wounds, Brian Kunimoto, M.D., and associates at the University of British Columbia think they may have found a secret weapon that comes in a tank.

It's nitric oxide gas.

A naturally produced, lipophilic molecule, nitric oxide, unlike antibiotics, easily penetrates biofilms, well-organized populations of bacteria that can form in chronic, difficult-to-heal wounds.

“I call it a smoking gun,” said Dr. Kunimoto, director of the Wound Healing Clinic at Vancouver Hospital and Health Sciences Centre.

He explained that nitric oxide combines with reactive oxygen to create “an entire soup of bacteriocidal intermediates” in a wound, and poisons the iron enzyme aconitase.

In the presence of this onslaught, “unless a bacterium can quickly develop into an anaerobic organism, it will die,” he said at the annual meeting of the Pacific Dermatologic Association.

Nitric oxide also deaminates DNA and enhances the damaging effects of hydrogen peroxide when it is present as a reactive oxygen intermediate.

Studies at the University of British Columbia found that counts of bacteria, including Staphylococcus aureus, pseudomonas, and methicillin-resistant S. aureus, plummeted to zero within hours of exposure to gaseous nitric oxide.

Home therapy involving nighttime exposure to the gas quickly healed a 2-year-old, nonhealing ankle ulcer in a 55-year-old man with severe venous disease, said Dr. Kunimoto, who recently published the case (J. Cutan. Med. Surg. 2004;8:233–9).

“This is remarkable for this gentleman, [considering] we worked on him for 2 years and got nowhere,” he said. “We've shifted the balance in favor of the host.”

The Canadian government has recently approved funding for a large study of nitric oxide gas to see if the results can be duplicated in other nonhealing wounds.

How to Identify Wound Types

Contamination

▸ Example: Fall from a bike, abraded skin.

▸ Bacteria: “Just passing through.”

▸ Signs and symptoms: None.

▸ Healing: Not compromised.

▸ Testing: None necessary.

▸ Treatment: Cleansing with normal saline.

Simple Colonization

▸ Example: Wound of a few days' duration.

▸ Bacteria: Living in the wound, but planktonic and disorganized.

▸ Signs and symptoms: None of note.

▸ Healing: Not compromised.

▸ Testing: None required.

▸ Treatment: Cleansing with normal saline.

Complicated Colonization (Biofilm)

▸ Example: Chronic wound.

▸ Bacteria: Significant in numbers and virulence. Well organized, often as a “biofilm.”

▸ Signs and symptoms: New onset of wound pain and wound-bed deterioration (granulation tissue loss, friability of granulation tissue).

▸ Healing: Compromised.

▸ Testing: None required.

▸ Treatment: Aggressive debridement, possibly with adjunctive antimicrobial measures (such as manuka honey or starch iodine).

Clinical Infection (Rare)

▸ Example: Markedly worsening chronic wound.

▸ Bacteria: Very significant in numbers and virulence.

▸ Signs and symptoms: Significant in numbers and virulence. Well organized, often as “biofilm.” There is evidence of a host inflammatory response (cellulitis) and possible systemic toxicity (fever and malaise).

▸ Healing: Compromised.

▸ Testing: Wound biopsy of base preferable to culture.

▸ Treatment: Systemic antibiotics.

Source: Dr. Kunimoto

VANCOUVER, B.C. — If physicians had a better understanding of the bacteriology of chronic wounds, they would stop overprescribing antibiotics for this indication—a strategy that rarely works and contributes to antibiotic resistance.

That's the assessment of Brian Kunimoto, M.D., director of the Wound Healing Clinic at the Vancouver Hospital and Health Sciences Centre and a member of the dermatology faculty at the University of British Columbia in Vancouver.

“Is there a problem with bacteria that grow in wounds, convincing some of us to do silly things like order useless tests, and worse yet, actually act on such useless information … [by] prescribing drugs that have no chance of working? I think it's a big problem, and it has nasty consequences,” said Dr. Kunimoto at the annual meeting of the Pacific Dermatologic Association.

Wounds come in many forms, with bacteria acting as attackers that have more or less of an impact depending on the vulnerability of the host as well as their own numbers and virulence, he said. (See chart.)

When bacteria are planktonic, they live an independent, nomadic life, disorganized and generally in a fluid state. In this form, they pose little threat to a human host.

However, when they begin to unite in an organized, adherent, cooperative “city-state,” they form a biofilm that poses a considerable challenge to physicians, Dr. Kunimoto said. Approximately 65% of all bacterial skin infections are related to biofilms characterized by their creamy, adherent properties.

“You brush off a biofilm every night when you brush your teeth. The classic biofilm is plaque on your teeth,” he said.

Biofilms, he explained, are made up of an exopolysaccharide matrix that allows for intracellular communication, production of a food supply, an escape route for waste, and most troubling, the sharing of genetic information.

A biofilm is polymicrobial, allowing for a harmonious existence of many forms of bacteria.

“I think bacteria do a better job at multiculturalism than our country, Canada,” he mused.

Culturing a biofilm is useless, he maintained. “It's no different from culturing your nose. You will find—wow!—bacteria! It gives us no really useful information.”

A culture may identify some bacteria present in the biofilm, but it will not characterize the rich and diverse population flourishing in a wound.

Moreover, neither topical nor systemic antibiotics penetrate a biofilm effectively, so they will be impotent, or worse, will provide highly useful resistance information to bacteria essentially sharing a bulletin board in a bustling city.

The best clinical practice for attacking biofilms is relentless debridement, according to Dr. Kunimoto.

“As I say to the residents in the clinic, 'Don't slough sloughing the slough.'

“Don't throw an antibiotic at this. Get out your tools and dig away. Don't give up,” he said.

Several antimicrobial agents can be used as adjuncts, including silver, starch iodine, and even manuka honey.

But the most critical treatment is repeated debridement, performed, if necessary, after a lengthy (2–3 hour) application of a topical anesthetic such as EMLA, he said.

Antibiotics are of use only in true clinical infections.

Nitric Oxide Gas Wards Off Bacteria

In the frustrating war against chronic wounds, Brian Kunimoto, M.D., and associates at the University of British Columbia think they may have found a secret weapon that comes in a tank.

It's nitric oxide gas.

A naturally produced, lipophilic molecule, nitric oxide, unlike antibiotics, easily penetrates biofilms, well-organized populations of bacteria that can form in chronic, difficult-to-heal wounds.

“I call it a smoking gun,” said Dr. Kunimoto, director of the Wound Healing Clinic at Vancouver Hospital and Health Sciences Centre.

He explained that nitric oxide combines with reactive oxygen to create “an entire soup of bacteriocidal intermediates” in a wound, and poisons the iron enzyme aconitase.

In the presence of this onslaught, “unless a bacterium can quickly develop into an anaerobic organism, it will die,” he said at the annual meeting of the Pacific Dermatologic Association.

Nitric oxide also deaminates DNA and enhances the damaging effects of hydrogen peroxide when it is present as a reactive oxygen intermediate.

Studies at the University of British Columbia found that counts of bacteria, including Staphylococcus aureus, pseudomonas, and methicillin-resistant S. aureus, plummeted to zero within hours of exposure to gaseous nitric oxide.

Home therapy involving nighttime exposure to the gas quickly healed a 2-year-old, nonhealing ankle ulcer in a 55-year-old man with severe venous disease, said Dr. Kunimoto, who recently published the case (J. Cutan. Med. Surg. 2004;8:233–9).

“This is remarkable for this gentleman, [considering] we worked on him for 2 years and got nowhere,” he said. “We've shifted the balance in favor of the host.”

The Canadian government has recently approved funding for a large study of nitric oxide gas to see if the results can be duplicated in other nonhealing wounds.

How to Identify Wound Types

Contamination

▸ Example: Fall from a bike, abraded skin.

▸ Bacteria: “Just passing through.”

▸ Signs and symptoms: None.

▸ Healing: Not compromised.

▸ Testing: None necessary.

▸ Treatment: Cleansing with normal saline.

Simple Colonization

▸ Example: Wound of a few days' duration.

▸ Bacteria: Living in the wound, but planktonic and disorganized.

▸ Signs and symptoms: None of note.

▸ Healing: Not compromised.

▸ Testing: None required.

▸ Treatment: Cleansing with normal saline.

Complicated Colonization (Biofilm)

▸ Example: Chronic wound.

▸ Bacteria: Significant in numbers and virulence. Well organized, often as a “biofilm.”

▸ Signs and symptoms: New onset of wound pain and wound-bed deterioration (granulation tissue loss, friability of granulation tissue).

▸ Healing: Compromised.

▸ Testing: None required.

▸ Treatment: Aggressive debridement, possibly with adjunctive antimicrobial measures (such as manuka honey or starch iodine).

Clinical Infection (Rare)

▸ Example: Markedly worsening chronic wound.

▸ Bacteria: Very significant in numbers and virulence.

▸ Signs and symptoms: Significant in numbers and virulence. Well organized, often as “biofilm.” There is evidence of a host inflammatory response (cellulitis) and possible systemic toxicity (fever and malaise).

▸ Healing: Compromised.

▸ Testing: Wound biopsy of base preferable to culture.

▸ Treatment: Systemic antibiotics.

Source: Dr. Kunimoto

VANCOUVER, B.C. — The battle against atopic dermatitis and eczema is often won or lost in the home, and educating parents by giving them simple and practical instructions can enhance the daily management of the diseases in children, Alfons Krol, M.D., said at the annual meeting of the Pacific Dermatologic Association.

The message that meaningful parental education is pivotal to success, and that without it, no other therapy is bound to be successful, is highlighted in a provocative study from the United Kingdom, said Dr. Krol, professor and director of pediatric dermatology at Oregon Health and Science University, Portland.

In the study from Sheffield (England) Children's Hospital, a specialist dermatology nurse spent at least 40 minutes demonstrating how to apply topical therapy and offering general eczema education to the families of 51 children with poorly controlled atopic dermatitis.

Lessons were reinforced by the nurse at subsequent visits (Br. J. Dermatol. 2003;149:582–9).

Within 1 year, eczema severity had declined 89%, attributable to a remarkable 800% increase in the use of emollients. There was no overall increase in the use or potency of topical steroids.

Dr. Krol suggests giving parents tangible, concrete advice.

For example, Dr. Krol draws on a study from Wales in prescribing topical medications according to fingertip units. The medications can be easily squeezed out onto a parent's pointer finger, to ensure they are applying a proper amount (Br. J. Dermatol. 1998;138:293–6).

At another recent meeting, Alfred Lane, M.D., cited the same Sheffield Children's Hospital study and explained how its principles can be applied to emollients.

He instructs families to use petroleum jelly according to the size of the jars. Parents of a 4- or 5-year-old should be using a 14-ounce tub every other week, he said.

“I try to talk [teenaged patients] into using a pound a week,” said Dr. Lane, professor of dermatology and pediatrics and chairman of dermatology at Stanford (Calif.) University.

At each visit, he simply asks patients or parents how many jars they've used, Dr. Lane said at the annual meeting of the California Society of Dermatology and Dermatologic Surgery.

Other educational messages are vital to convey as well. These include:

▸ Atopic dermatitis is not a food allergy. Many children with eczema have IgE antibodies to molds, pollens, and grasses, and they may have food allergies as well; parents should be clear about the fact that their children's eczema is not caused by what they eat.

Dr. Lane described an infant who developed zinc deficiency and severe protein malnutrition when a foster mother accepted a naturopath's advice to limit the child's diet to goat's milk and rice milk in the belief that everything else was worsening the child's atopic dermatitis.

He emphasized that extreme diets do not improve eczema and may pose serious risks to children.

▸ Topical steroids are not what's worrying Congress and major league baseball. The word steroid brings to mind oversized muscles, “'roid rage,” and testicular shrinkage. Physicians should not assume that parents understand that there is a difference between the substances that are banned in competitive sports and the medicines prescribed for atopic dermatitis.

▸ Emollients don't have to be fancy to work. “There's certainly nothing cheaper and nothing as nonsensitizing as petrolatum,” Dr. Krol said.

He advises parents to apply it within 1 minute of bathing, all over a child's body before swimming, and over the perioral area before and after feeding a baby who has atopic dermatitis.

▸ Bathing is good. Sponging is bad. A 15- to 20-minute, not-too-hot daily bath followed by a coating of petroleum jelly is beneficial for atopic dermatitis.

“Sponging is the worst thing for a child's skin,” Dr. Krol explained.

“It chaps it, encourages microfissures, and worsens eczema,” he said.

VANCOUVER, B.C. — The battle against atopic dermatitis and eczema is often won or lost in the home, and educating parents by giving them simple and practical instructions can enhance the daily management of the diseases in children, Alfons Krol, M.D., said at the annual meeting of the Pacific Dermatologic Association.

The message that meaningful parental education is pivotal to success, and that without it, no other therapy is bound to be successful, is highlighted in a provocative study from the United Kingdom, said Dr. Krol, professor and director of pediatric dermatology at Oregon Health and Science University, Portland.

In the study from Sheffield (England) Children's Hospital, a specialist dermatology nurse spent at least 40 minutes demonstrating how to apply topical therapy and offering general eczema education to the families of 51 children with poorly controlled atopic dermatitis.

Lessons were reinforced by the nurse at subsequent visits (Br. J. Dermatol. 2003;149:582–9).

Within 1 year, eczema severity had declined 89%, attributable to a remarkable 800% increase in the use of emollients. There was no overall increase in the use or potency of topical steroids.

Dr. Krol suggests giving parents tangible, concrete advice.

For example, Dr. Krol draws on a study from Wales in prescribing topical medications according to fingertip units. The medications can be easily squeezed out onto a parent's pointer finger, to ensure they are applying a proper amount (Br. J. Dermatol. 1998;138:293–6).

At another recent meeting, Alfred Lane, M.D., cited the same Sheffield Children's Hospital study and explained how its principles can be applied to emollients.

He instructs families to use petroleum jelly according to the size of the jars. Parents of a 4- or 5-year-old should be using a 14-ounce tub every other week, he said.

“I try to talk [teenaged patients] into using a pound a week,” said Dr. Lane, professor of dermatology and pediatrics and chairman of dermatology at Stanford (Calif.) University.

At each visit, he simply asks patients or parents how many jars they've used, Dr. Lane said at the annual meeting of the California Society of Dermatology and Dermatologic Surgery.

Other educational messages are vital to convey as well. These include:

▸ Atopic dermatitis is not a food allergy. Many children with eczema have IgE antibodies to molds, pollens, and grasses, and they may have food allergies as well; parents should be clear about the fact that their children's eczema is not caused by what they eat.

Dr. Lane described an infant who developed zinc deficiency and severe protein malnutrition when a foster mother accepted a naturopath's advice to limit the child's diet to goat's milk and rice milk in the belief that everything else was worsening the child's atopic dermatitis.

He emphasized that extreme diets do not improve eczema and may pose serious risks to children.

▸ Topical steroids are not what's worrying Congress and major league baseball. The word steroid brings to mind oversized muscles, “'roid rage,” and testicular shrinkage. Physicians should not assume that parents understand that there is a difference between the substances that are banned in competitive sports and the medicines prescribed for atopic dermatitis.

▸ Emollients don't have to be fancy to work. “There's certainly nothing cheaper and nothing as nonsensitizing as petrolatum,” Dr. Krol said.

He advises parents to apply it within 1 minute of bathing, all over a child's body before swimming, and over the perioral area before and after feeding a baby who has atopic dermatitis.

▸ Bathing is good. Sponging is bad. A 15- to 20-minute, not-too-hot daily bath followed by a coating of petroleum jelly is beneficial for atopic dermatitis.

“Sponging is the worst thing for a child's skin,” Dr. Krol explained.

“It chaps it, encourages microfissures, and worsens eczema,” he said.

VANCOUVER, B.C. — The battle against atopic dermatitis and eczema is often won or lost in the home, and educating parents by giving them simple and practical instructions can enhance the daily management of the diseases in children, Alfons Krol, M.D., said at the annual meeting of the Pacific Dermatologic Association.

The message that meaningful parental education is pivotal to success, and that without it, no other therapy is bound to be successful, is highlighted in a provocative study from the United Kingdom, said Dr. Krol, professor and director of pediatric dermatology at Oregon Health and Science University, Portland.

In the study from Sheffield (England) Children's Hospital, a specialist dermatology nurse spent at least 40 minutes demonstrating how to apply topical therapy and offering general eczema education to the families of 51 children with poorly controlled atopic dermatitis.

Lessons were reinforced by the nurse at subsequent visits (Br. J. Dermatol. 2003;149:582–9).

Within 1 year, eczema severity had declined 89%, attributable to a remarkable 800% increase in the use of emollients. There was no overall increase in the use or potency of topical steroids.

Dr. Krol suggests giving parents tangible, concrete advice.

For example, Dr. Krol draws on a study from Wales in prescribing topical medications according to fingertip units. The medications can be easily squeezed out onto a parent's pointer finger, to ensure they are applying a proper amount (Br. J. Dermatol. 1998;138:293–6).

At another recent meeting, Alfred Lane, M.D., cited the same Sheffield Children's Hospital study and explained how its principles can be applied to emollients.

He instructs families to use petroleum jelly according to the size of the jars. Parents of a 4- or 5-year-old should be using a 14-ounce tub every other week, he said.

“I try to talk [teenaged patients] into using a pound a week,” said Dr. Lane, professor of dermatology and pediatrics and chairman of dermatology at Stanford (Calif.) University.

At each visit, he simply asks patients or parents how many jars they've used, Dr. Lane said at the annual meeting of the California Society of Dermatology and Dermatologic Surgery.

Other educational messages are vital to convey as well. These include:

▸ Atopic dermatitis is not a food allergy. Many children with eczema have IgE antibodies to molds, pollens, and grasses, and they may have food allergies as well; parents should be clear about the fact that their children's eczema is not caused by what they eat.

Dr. Lane described an infant who developed zinc deficiency and severe protein malnutrition when a foster mother accepted a naturopath's advice to limit the child's diet to goat's milk and rice milk in the belief that everything else was worsening the child's atopic dermatitis.

He emphasized that extreme diets do not improve eczema and may pose serious risks to children.

▸ Topical steroids are not what's worrying Congress and major league baseball. The word steroid brings to mind oversized muscles, “'roid rage,” and testicular shrinkage. Physicians should not assume that parents understand that there is a difference between the substances that are banned in competitive sports and the medicines prescribed for atopic dermatitis.

▸ Emollients don't have to be fancy to work. “There's certainly nothing cheaper and nothing as nonsensitizing as petrolatum,” Dr. Krol said.

He advises parents to apply it within 1 minute of bathing, all over a child's body before swimming, and over the perioral area before and after feeding a baby who has atopic dermatitis.

▸ Bathing is good. Sponging is bad. A 15- to 20-minute, not-too-hot daily bath followed by a coating of petroleum jelly is beneficial for atopic dermatitis.

“Sponging is the worst thing for a child's skin,” Dr. Krol explained.

“It chaps it, encourages microfissures, and worsens eczema,” he said.

SAN DIEGO — The prevalence of gastroesophageal reflux disease symptoms in patients with type 2 diabetes is more than twice what is seen in the normal adult population, and appears to be especially high in patients with diabetic neuropathy.

Khushbu Chandrarana, M.D., and her associates conducted a prospective study of 150 patients aged 18 to 82 years with type 2 diabetes. The participants had not been diagnosed with other conditions, such as angina, that might explain gastroesophageal reflux disease (GERD)-type symptoms.

Patients with a GERD diagnosis prior to onset of their diabetes were not included in the study, which was presented as a poster at the annual meeting of the Endocrine Society.

A questionnaire given to eligible consecutive patients targeted the five most common symptoms of GERD: heartburn at least once a week, hoarseness, chronic cough, chest pain, and regurgitation.

A total of 40% of patients reported at least 1 GERD symptom and 30% reported having heartburn at least weekly. The prevalence of weekly heartburn in U.S. adults is 14%, said Dr. Chandrarana, a resident in the divisions of endocrinology and gastrointestinal medicine at Saint Peter's University Hospital, New Brunswick, N.J.

Among the 46 patients with neuropathy, 27 (59%) reported GERD symptoms, compared with 34 of the 104 diabetic patients (33%) who did not have neuropathy.

“Since experience of heartburn is likely to be blunted by neuropathy, the actual incidence of GERD may be even higher,” Dr. Chandrarana noted.

She encouraged physicians to be sensitive to the possibility that their patients with diabetes might also have GERD, a treatable disease.

The connection makes sense, she pointed out, since the pathophysiology of GERD involves delayed gastric emptying, a common complication of patients with diabetic neuropathy.

SAN DIEGO — The prevalence of gastroesophageal reflux disease symptoms in patients with type 2 diabetes is more than twice what is seen in the normal adult population, and appears to be especially high in patients with diabetic neuropathy.

Khushbu Chandrarana, M.D., and her associates conducted a prospective study of 150 patients aged 18 to 82 years with type 2 diabetes. The participants had not been diagnosed with other conditions, such as angina, that might explain gastroesophageal reflux disease (GERD)-type symptoms.

Patients with a GERD diagnosis prior to onset of their diabetes were not included in the study, which was presented as a poster at the annual meeting of the Endocrine Society.

A questionnaire given to eligible consecutive patients targeted the five most common symptoms of GERD: heartburn at least once a week, hoarseness, chronic cough, chest pain, and regurgitation.

A total of 40% of patients reported at least 1 GERD symptom and 30% reported having heartburn at least weekly. The prevalence of weekly heartburn in U.S. adults is 14%, said Dr. Chandrarana, a resident in the divisions of endocrinology and gastrointestinal medicine at Saint Peter's University Hospital, New Brunswick, N.J.

Among the 46 patients with neuropathy, 27 (59%) reported GERD symptoms, compared with 34 of the 104 diabetic patients (33%) who did not have neuropathy.

“Since experience of heartburn is likely to be blunted by neuropathy, the actual incidence of GERD may be even higher,” Dr. Chandrarana noted.

She encouraged physicians to be sensitive to the possibility that their patients with diabetes might also have GERD, a treatable disease.

The connection makes sense, she pointed out, since the pathophysiology of GERD involves delayed gastric emptying, a common complication of patients with diabetic neuropathy.

SAN DIEGO — The prevalence of gastroesophageal reflux disease symptoms in patients with type 2 diabetes is more than twice what is seen in the normal adult population, and appears to be especially high in patients with diabetic neuropathy.

Khushbu Chandrarana, M.D., and her associates conducted a prospective study of 150 patients aged 18 to 82 years with type 2 diabetes. The participants had not been diagnosed with other conditions, such as angina, that might explain gastroesophageal reflux disease (GERD)-type symptoms.

Patients with a GERD diagnosis prior to onset of their diabetes were not included in the study, which was presented as a poster at the annual meeting of the Endocrine Society.

A questionnaire given to eligible consecutive patients targeted the five most common symptoms of GERD: heartburn at least once a week, hoarseness, chronic cough, chest pain, and regurgitation.

A total of 40% of patients reported at least 1 GERD symptom and 30% reported having heartburn at least weekly. The prevalence of weekly heartburn in U.S. adults is 14%, said Dr. Chandrarana, a resident in the divisions of endocrinology and gastrointestinal medicine at Saint Peter's University Hospital, New Brunswick, N.J.

Among the 46 patients with neuropathy, 27 (59%) reported GERD symptoms, compared with 34 of the 104 diabetic patients (33%) who did not have neuropathy.

“Since experience of heartburn is likely to be blunted by neuropathy, the actual incidence of GERD may be even higher,” Dr. Chandrarana noted.

She encouraged physicians to be sensitive to the possibility that their patients with diabetes might also have GERD, a treatable disease.

The connection makes sense, she pointed out, since the pathophysiology of GERD involves delayed gastric emptying, a common complication of patients with diabetic neuropathy.

SAN DIEGO — A small study has found that treating obstructive sleep apnea in patients with polycystic ovary syndrome lowered their cortisol levels at night as well as during the daytime.

Obstructive sleep apnea symptoms also greatly improved in five nondiabetic PCOS patients who received continuous positive airway pressure (CPAP) for 8 weeks as part of a study presented at the annual meeting of the Endocrine Society.

Previous research has determined that the risk of obstructive sleep apnea is 30-fold to 40-fold higher in women with PCOS compared with weight-matched controls. It has been theorized that there may be a link between obstructive sleep apnea and the metabolic and hormonal abnormalities associated with the disease.

“These findings strongly suggest that obstructive sleep apnea is likely to contribute to elevated cortisol levels in women with PCOS and could play a role in the risk for adverse metabolic alterations in this patient population,” concluded researchers Eve Van Cauter, Ph.D., and Esra Tasali, M.D., of the department of medicine at the University of Chicago, who presented a poster at the meeting.

Subjects in the study were in their early to mid-30s and had a mean body mass index (kg/m

CPAP treatments were administered for 8 weeks at the patients' homes, with compliance confirmed by built-in monitors.

Following therapy, mean 24-hour cortisol levels fell from 10.2 mcg/dL to 7.7 mcg/dL. Daytime cortisol levels fell from 10.3 mcg/dL to 7.9 mcg/dL, whereas nighttime cortisol dropped from 10.1 mcg/dL to 7.5 mcg/dL. These decreases were all statistically significant.

The cortisol nadir declined by 40%.

“Interestingly, this decrease in the nadir was associated with the severity of patients' sleep apnea,” Dr. Tasali, a pulmonologist and sleep researcher at the university, said in an interview.

CPAP may emerge as a treatment modality in some patients, not only to alleviate symptoms of obstructive sleep apnea, but also to independently target hormonally and metabolically driven symptoms.

A larger study is planned and will involve more patients with PCOS and obstructive sleep apnea, as well as obese women with sleep apnea who do not have PCOS, said Dr. Van Cauter, a professor of medicine at the university.

SAN DIEGO — A small study has found that treating obstructive sleep apnea in patients with polycystic ovary syndrome lowered their cortisol levels at night as well as during the daytime.

Obstructive sleep apnea symptoms also greatly improved in five nondiabetic PCOS patients who received continuous positive airway pressure (CPAP) for 8 weeks as part of a study presented at the annual meeting of the Endocrine Society.

Previous research has determined that the risk of obstructive sleep apnea is 30-fold to 40-fold higher in women with PCOS compared with weight-matched controls. It has been theorized that there may be a link between obstructive sleep apnea and the metabolic and hormonal abnormalities associated with the disease.

“These findings strongly suggest that obstructive sleep apnea is likely to contribute to elevated cortisol levels in women with PCOS and could play a role in the risk for adverse metabolic alterations in this patient population,” concluded researchers Eve Van Cauter, Ph.D., and Esra Tasali, M.D., of the department of medicine at the University of Chicago, who presented a poster at the meeting.

Subjects in the study were in their early to mid-30s and had a mean body mass index (kg/m

CPAP treatments were administered for 8 weeks at the patients' homes, with compliance confirmed by built-in monitors.

Following therapy, mean 24-hour cortisol levels fell from 10.2 mcg/dL to 7.7 mcg/dL. Daytime cortisol levels fell from 10.3 mcg/dL to 7.9 mcg/dL, whereas nighttime cortisol dropped from 10.1 mcg/dL to 7.5 mcg/dL. These decreases were all statistically significant.

The cortisol nadir declined by 40%.

“Interestingly, this decrease in the nadir was associated with the severity of patients' sleep apnea,” Dr. Tasali, a pulmonologist and sleep researcher at the university, said in an interview.

CPAP may emerge as a treatment modality in some patients, not only to alleviate symptoms of obstructive sleep apnea, but also to independently target hormonally and metabolically driven symptoms.

A larger study is planned and will involve more patients with PCOS and obstructive sleep apnea, as well as obese women with sleep apnea who do not have PCOS, said Dr. Van Cauter, a professor of medicine at the university.

SAN DIEGO — A small study has found that treating obstructive sleep apnea in patients with polycystic ovary syndrome lowered their cortisol levels at night as well as during the daytime.

Obstructive sleep apnea symptoms also greatly improved in five nondiabetic PCOS patients who received continuous positive airway pressure (CPAP) for 8 weeks as part of a study presented at the annual meeting of the Endocrine Society.

Previous research has determined that the risk of obstructive sleep apnea is 30-fold to 40-fold higher in women with PCOS compared with weight-matched controls. It has been theorized that there may be a link between obstructive sleep apnea and the metabolic and hormonal abnormalities associated with the disease.

“These findings strongly suggest that obstructive sleep apnea is likely to contribute to elevated cortisol levels in women with PCOS and could play a role in the risk for adverse metabolic alterations in this patient population,” concluded researchers Eve Van Cauter, Ph.D., and Esra Tasali, M.D., of the department of medicine at the University of Chicago, who presented a poster at the meeting.

Subjects in the study were in their early to mid-30s and had a mean body mass index (kg/m

CPAP treatments were administered for 8 weeks at the patients' homes, with compliance confirmed by built-in monitors.

Following therapy, mean 24-hour cortisol levels fell from 10.2 mcg/dL to 7.7 mcg/dL. Daytime cortisol levels fell from 10.3 mcg/dL to 7.9 mcg/dL, whereas nighttime cortisol dropped from 10.1 mcg/dL to 7.5 mcg/dL. These decreases were all statistically significant.

The cortisol nadir declined by 40%.

“Interestingly, this decrease in the nadir was associated with the severity of patients' sleep apnea,” Dr. Tasali, a pulmonologist and sleep researcher at the university, said in an interview.

CPAP may emerge as a treatment modality in some patients, not only to alleviate symptoms of obstructive sleep apnea, but also to independently target hormonally and metabolically driven symptoms.

A larger study is planned and will involve more patients with PCOS and obstructive sleep apnea, as well as obese women with sleep apnea who do not have PCOS, said Dr. Van Cauter, a professor of medicine at the university.

SAN DIEGO — Young women with polycystic ovary syndrome have evidence of endothelial dysfunction and low-grade, chronic inflammatory markers characteristic of much older patients, researchers reported at the annual meeting of the Endocrine Society.

Evanthia Diamanti-Kandarakis, M.D., and associates at Laiko Hospital of the University of Athens compared endothelial function and inflammatory cytokines in 25 women with PCOS and 20 age-matched controls with similar body mass index (BMI) measurements and waist-hip ratios. The women were in their mid to late 20s and had BMIs of about 26–29 kg/m

Endothelial function was determined by flow-mediated dilatation of the brachial artery on ultrasound, plus endothelin-1 (ET-1) plasma levels. Numerous cytokines were measured in blood to assess arterial inflammation.

Subjects with PCOS had significantly lower percentages of flow-mediated dilatation than controls (3.47% vs. 9.26%). Nitrate-induced dilatation, measured to exclude smooth muscle cell injury, was not significantly different in the two groups. Significantly higher levels of ET-1, intracellular adhesion molecules (ICAMs), vascular cell adhesion molecules (VCAMs), and C-reactive protein were found in PCOS subjects, compared with controls. E-selectin levels did not differ between groups.

In PCOS “the lining of the arteries is affected and at the same time, the molecules are sticking to each other and to the vessel wall, leading to a compromised circulation as would be seen in a woman much older” than these subjects, Dr. Diamanti-Kandarakis said at a press conference at the meeting.

As expected, testosterone levels were significantly elevated in women with PCOS.

Asked to advise clinicians on how to use the information, she pointed out that a multiple regression analysis determined that the best predictors of endothelial damage in PCOS subjects were elevated levels of testosterone and CRP. Young PCOS patients with high levels of both should be closely followed for cardiovascular consequences of the syndrome.

“We cannot assume that all women with PCOS have [endothelial dysfunction]. There are different subtypes of the disease,” Dr. Diamanti-Kandarakis said.

SAN DIEGO — Young women with polycystic ovary syndrome have evidence of endothelial dysfunction and low-grade, chronic inflammatory markers characteristic of much older patients, researchers reported at the annual meeting of the Endocrine Society.

Evanthia Diamanti-Kandarakis, M.D., and associates at Laiko Hospital of the University of Athens compared endothelial function and inflammatory cytokines in 25 women with PCOS and 20 age-matched controls with similar body mass index (BMI) measurements and waist-hip ratios. The women were in their mid to late 20s and had BMIs of about 26–29 kg/m

Endothelial function was determined by flow-mediated dilatation of the brachial artery on ultrasound, plus endothelin-1 (ET-1) plasma levels. Numerous cytokines were measured in blood to assess arterial inflammation.

Subjects with PCOS had significantly lower percentages of flow-mediated dilatation than controls (3.47% vs. 9.26%). Nitrate-induced dilatation, measured to exclude smooth muscle cell injury, was not significantly different in the two groups. Significantly higher levels of ET-1, intracellular adhesion molecules (ICAMs), vascular cell adhesion molecules (VCAMs), and C-reactive protein were found in PCOS subjects, compared with controls. E-selectin levels did not differ between groups.

In PCOS “the lining of the arteries is affected and at the same time, the molecules are sticking to each other and to the vessel wall, leading to a compromised circulation as would be seen in a woman much older” than these subjects, Dr. Diamanti-Kandarakis said at a press conference at the meeting.

As expected, testosterone levels were significantly elevated in women with PCOS.

Asked to advise clinicians on how to use the information, she pointed out that a multiple regression analysis determined that the best predictors of endothelial damage in PCOS subjects were elevated levels of testosterone and CRP. Young PCOS patients with high levels of both should be closely followed for cardiovascular consequences of the syndrome.

“We cannot assume that all women with PCOS have [endothelial dysfunction]. There are different subtypes of the disease,” Dr. Diamanti-Kandarakis said.

SAN DIEGO — Young women with polycystic ovary syndrome have evidence of endothelial dysfunction and low-grade, chronic inflammatory markers characteristic of much older patients, researchers reported at the annual meeting of the Endocrine Society.

Evanthia Diamanti-Kandarakis, M.D., and associates at Laiko Hospital of the University of Athens compared endothelial function and inflammatory cytokines in 25 women with PCOS and 20 age-matched controls with similar body mass index (BMI) measurements and waist-hip ratios. The women were in their mid to late 20s and had BMIs of about 26–29 kg/m

Endothelial function was determined by flow-mediated dilatation of the brachial artery on ultrasound, plus endothelin-1 (ET-1) plasma levels. Numerous cytokines were measured in blood to assess arterial inflammation.

Subjects with PCOS had significantly lower percentages of flow-mediated dilatation than controls (3.47% vs. 9.26%). Nitrate-induced dilatation, measured to exclude smooth muscle cell injury, was not significantly different in the two groups. Significantly higher levels of ET-1, intracellular adhesion molecules (ICAMs), vascular cell adhesion molecules (VCAMs), and C-reactive protein were found in PCOS subjects, compared with controls. E-selectin levels did not differ between groups.

In PCOS “the lining of the arteries is affected and at the same time, the molecules are sticking to each other and to the vessel wall, leading to a compromised circulation as would be seen in a woman much older” than these subjects, Dr. Diamanti-Kandarakis said at a press conference at the meeting.

As expected, testosterone levels were significantly elevated in women with PCOS.

Asked to advise clinicians on how to use the information, she pointed out that a multiple regression analysis determined that the best predictors of endothelial damage in PCOS subjects were elevated levels of testosterone and CRP. Young PCOS patients with high levels of both should be closely followed for cardiovascular consequences of the syndrome.

“We cannot assume that all women with PCOS have [endothelial dysfunction]. There are different subtypes of the disease,” Dr. Diamanti-Kandarakis said.

SANTA BARBARA, CALIF. — Prenatal alcohol exposure is most likely to affect children's attention problems when it occurs during the third trimester, a prospective study of 492 children determined.

There is a high degree of correlation between teacher- and parent-assessed attention deficits in children exposed to alcohol in late pregnancy, compared with alcohol exposure during the first or second trimesters, Beth Nordstrom Bailey, Ph.D., and her associates reported at the annual meeting of the Research Society on Alcoholism.

“These findings provide yet one more piece of evidence that the timing of prenatal alcohol exposure impacts child outcomes,” concluded the investigators, who presented their study in poster form.

The study from East Tennessee State University in Johnson City, where Dr. Bailey serves on the department of family medicine faculty, carries substantial weight because it prospectively tracked women's substance abuse throughout pregnancy and followed their children for 6–7 years.

The cohort was from urban Detroit and was mostly made up of African Americans with a low socioeconomic status, 90% of whom agreed to participate in the follow-up study.

Caregivers completed the Achenbach Child Behavior Checklist. Classroom teachers completed the Achenbach Teacher Report Form. Both standardized tools include Attention Problems scales.

In a logistic regression analysis, third-trimester prenatal alcohol exposure independently correlated with attention problems as assessed by both caregivers and teachers. Lead levels and custody changes also correlated with attention scores as assessed by parents and caregivers. Violence exposure factored into the equation only when teachers' assessments were considered.

Prenatal exposure to cocaine, cigarettes, or alcohol during the first and second trimesters failed to independently correlate with later attention problems in children.

In an interview, Dr. Bailey explained that first-trimester exposures have the potential to affect global development of the fetus, possibly resulting in physical deformities, major cognitive impairment, and diminished growth.

In the third trimester, higher order functions are most affected. Alcohol exposure during this time appears to affect children's specific attention and behavior functions that can be readily assessed during the school-age years.

SANTA BARBARA, CALIF. — Prenatal alcohol exposure is most likely to affect children's attention problems when it occurs during the third trimester, a prospective study of 492 children determined.

There is a high degree of correlation between teacher- and parent-assessed attention deficits in children exposed to alcohol in late pregnancy, compared with alcohol exposure during the first or second trimesters, Beth Nordstrom Bailey, Ph.D., and her associates reported at the annual meeting of the Research Society on Alcoholism.

“These findings provide yet one more piece of evidence that the timing of prenatal alcohol exposure impacts child outcomes,” concluded the investigators, who presented their study in poster form.

The study from East Tennessee State University in Johnson City, where Dr. Bailey serves on the department of family medicine faculty, carries substantial weight because it prospectively tracked women's substance abuse throughout pregnancy and followed their children for 6–7 years.

The cohort was from urban Detroit and was mostly made up of African Americans with a low socioeconomic status, 90% of whom agreed to participate in the follow-up study.

Caregivers completed the Achenbach Child Behavior Checklist. Classroom teachers completed the Achenbach Teacher Report Form. Both standardized tools include Attention Problems scales.

In a logistic regression analysis, third-trimester prenatal alcohol exposure independently correlated with attention problems as assessed by both caregivers and teachers. Lead levels and custody changes also correlated with attention scores as assessed by parents and caregivers. Violence exposure factored into the equation only when teachers' assessments were considered.

Prenatal exposure to cocaine, cigarettes, or alcohol during the first and second trimesters failed to independently correlate with later attention problems in children.

In an interview, Dr. Bailey explained that first-trimester exposures have the potential to affect global development of the fetus, possibly resulting in physical deformities, major cognitive impairment, and diminished growth.

In the third trimester, higher order functions are most affected. Alcohol exposure during this time appears to affect children's specific attention and behavior functions that can be readily assessed during the school-age years.

SANTA BARBARA, CALIF. — Prenatal alcohol exposure is most likely to affect children's attention problems when it occurs during the third trimester, a prospective study of 492 children determined.

There is a high degree of correlation between teacher- and parent-assessed attention deficits in children exposed to alcohol in late pregnancy, compared with alcohol exposure during the first or second trimesters, Beth Nordstrom Bailey, Ph.D., and her associates reported at the annual meeting of the Research Society on Alcoholism.

“These findings provide yet one more piece of evidence that the timing of prenatal alcohol exposure impacts child outcomes,” concluded the investigators, who presented their study in poster form.

The study from East Tennessee State University in Johnson City, where Dr. Bailey serves on the department of family medicine faculty, carries substantial weight because it prospectively tracked women's substance abuse throughout pregnancy and followed their children for 6–7 years.

The cohort was from urban Detroit and was mostly made up of African Americans with a low socioeconomic status, 90% of whom agreed to participate in the follow-up study.

Caregivers completed the Achenbach Child Behavior Checklist. Classroom teachers completed the Achenbach Teacher Report Form. Both standardized tools include Attention Problems scales.

In a logistic regression analysis, third-trimester prenatal alcohol exposure independently correlated with attention problems as assessed by both caregivers and teachers. Lead levels and custody changes also correlated with attention scores as assessed by parents and caregivers. Violence exposure factored into the equation only when teachers' assessments were considered.

Prenatal exposure to cocaine, cigarettes, or alcohol during the first and second trimesters failed to independently correlate with later attention problems in children.

In an interview, Dr. Bailey explained that first-trimester exposures have the potential to affect global development of the fetus, possibly resulting in physical deformities, major cognitive impairment, and diminished growth.

In the third trimester, higher order functions are most affected. Alcohol exposure during this time appears to affect children's specific attention and behavior functions that can be readily assessed during the school-age years.

SAN DIEGO — A long-term study of dehydroepiandrosterone supplementation in elderly men and women found no effect on body composition, muscle strength or performance, glucose metabolism, or quality of life.

There was a “trend … of borderline significance” for the effect of the popular supplement on bone mineral density, which was the only positive finding that approached statistical significance in the 2-year study, said K. Sreekumaran Nair, M.D., professor of endocrinology at the Mayo Medical School in Rochester, Minn.

Dr. Nair presented results of one of the few well-designed, long-term studies of dehydroepiandrosterone (DHEA) supplementation at the annual meeting of the Endocrine Society.

To provide an objective, long-term perspective, Dr. Nair and associates recruited 120 men and women (mean age, 69 and 70 years, respectively) with low dehydroepiandrosterone sulfate (DHEAS) levels, defined as concentrations below the 15th percentile for normal young adults. In men, bioavailable testosterone was also low, falling more than 1.5 standard deviations below the mean.

Eligible participants were randomized to receive supplemental DHEA (50 mg/day for women and 75 mg/day for men) or placebo for 20–24 months.

As expected, individuals taking DHEA had significant increases in DHEAS levels. Estradiol levels also rose significantly in both women and men taking DHEA. In women only, testosterone levels increased significantly, from a mean 30 ng/dL to a mean 45 ng/dL.

At enrollment and upon completion of the study, researchers conducted a wide variety of tests to identify any potential changes in muscle function, fat distribution, and carbohydrate metabolism. These tests included maximum oxygen consumption, chest press, isometric and double-knee extension, thigh muscle mass by single-slice CT, and fat-free mass by DXA to evaluate muscle function, ratio of visceral to total fat to characterize fat distribution, and fasting glucose and insulin for carbohydrate metabolism. Also measured was bone mineral density at the L2-L4 spine, femur neck, total hip, distal radius, and ultradistal radius.

Quality of life was assessed by using both physical and mental competency scores. Dr. Nair ticked through the results methodically, demonstrating “no difference at all” in subjects taking DHEA vs. placebo on myriad measures. “Body fat-free mass? The same story,” he said at one point.

Bone mineral density did improve slightly in subjects who were taking DHEA, compared with those taking placebo, mainly due to a 5.7% relative increase in ultradistal forearm BMD in women and a 2.6% relative increase in femur neck BMD in men. But Dr. Nair characterized the overall trend in BMD as “weak” evidence of DHEA's effectiveness.

On a more positive note, no adverse effects were associated with taking DHEA long term, Dr. Nair said during a symposium at the meeting.

SAN DIEGO — A long-term study of dehydroepiandrosterone supplementation in elderly men and women found no effect on body composition, muscle strength or performance, glucose metabolism, or quality of life.

There was a “trend … of borderline significance” for the effect of the popular supplement on bone mineral density, which was the only positive finding that approached statistical significance in the 2-year study, said K. Sreekumaran Nair, M.D., professor of endocrinology at the Mayo Medical School in Rochester, Minn.

Dr. Nair presented results of one of the few well-designed, long-term studies of dehydroepiandrosterone (DHEA) supplementation at the annual meeting of the Endocrine Society.

To provide an objective, long-term perspective, Dr. Nair and associates recruited 120 men and women (mean age, 69 and 70 years, respectively) with low dehydroepiandrosterone sulfate (DHEAS) levels, defined as concentrations below the 15th percentile for normal young adults. In men, bioavailable testosterone was also low, falling more than 1.5 standard deviations below the mean.

Eligible participants were randomized to receive supplemental DHEA (50 mg/day for women and 75 mg/day for men) or placebo for 20–24 months.

As expected, individuals taking DHEA had significant increases in DHEAS levels. Estradiol levels also rose significantly in both women and men taking DHEA. In women only, testosterone levels increased significantly, from a mean 30 ng/dL to a mean 45 ng/dL.

At enrollment and upon completion of the study, researchers conducted a wide variety of tests to identify any potential changes in muscle function, fat distribution, and carbohydrate metabolism. These tests included maximum oxygen consumption, chest press, isometric and double-knee extension, thigh muscle mass by single-slice CT, and fat-free mass by DXA to evaluate muscle function, ratio of visceral to total fat to characterize fat distribution, and fasting glucose and insulin for carbohydrate metabolism. Also measured was bone mineral density at the L2-L4 spine, femur neck, total hip, distal radius, and ultradistal radius.

Quality of life was assessed by using both physical and mental competency scores. Dr. Nair ticked through the results methodically, demonstrating “no difference at all” in subjects taking DHEA vs. placebo on myriad measures. “Body fat-free mass? The same story,” he said at one point.

Bone mineral density did improve slightly in subjects who were taking DHEA, compared with those taking placebo, mainly due to a 5.7% relative increase in ultradistal forearm BMD in women and a 2.6% relative increase in femur neck BMD in men. But Dr. Nair characterized the overall trend in BMD as “weak” evidence of DHEA's effectiveness.

On a more positive note, no adverse effects were associated with taking DHEA long term, Dr. Nair said during a symposium at the meeting.

SAN DIEGO — A long-term study of dehydroepiandrosterone supplementation in elderly men and women found no effect on body composition, muscle strength or performance, glucose metabolism, or quality of life.

There was a “trend … of borderline significance” for the effect of the popular supplement on bone mineral density, which was the only positive finding that approached statistical significance in the 2-year study, said K. Sreekumaran Nair, M.D., professor of endocrinology at the Mayo Medical School in Rochester, Minn.

Dr. Nair presented results of one of the few well-designed, long-term studies of dehydroepiandrosterone (DHEA) supplementation at the annual meeting of the Endocrine Society.

To provide an objective, long-term perspective, Dr. Nair and associates recruited 120 men and women (mean age, 69 and 70 years, respectively) with low dehydroepiandrosterone sulfate (DHEAS) levels, defined as concentrations below the 15th percentile for normal young adults. In men, bioavailable testosterone was also low, falling more than 1.5 standard deviations below the mean.

Eligible participants were randomized to receive supplemental DHEA (50 mg/day for women and 75 mg/day for men) or placebo for 20–24 months.

As expected, individuals taking DHEA had significant increases in DHEAS levels. Estradiol levels also rose significantly in both women and men taking DHEA. In women only, testosterone levels increased significantly, from a mean 30 ng/dL to a mean 45 ng/dL.

At enrollment and upon completion of the study, researchers conducted a wide variety of tests to identify any potential changes in muscle function, fat distribution, and carbohydrate metabolism. These tests included maximum oxygen consumption, chest press, isometric and double-knee extension, thigh muscle mass by single-slice CT, and fat-free mass by DXA to evaluate muscle function, ratio of visceral to total fat to characterize fat distribution, and fasting glucose and insulin for carbohydrate metabolism. Also measured was bone mineral density at the L2-L4 spine, femur neck, total hip, distal radius, and ultradistal radius.

Quality of life was assessed by using both physical and mental competency scores. Dr. Nair ticked through the results methodically, demonstrating “no difference at all” in subjects taking DHEA vs. placebo on myriad measures. “Body fat-free mass? The same story,” he said at one point.

Bone mineral density did improve slightly in subjects who were taking DHEA, compared with those taking placebo, mainly due to a 5.7% relative increase in ultradistal forearm BMD in women and a 2.6% relative increase in femur neck BMD in men. But Dr. Nair characterized the overall trend in BMD as “weak” evidence of DHEA's effectiveness.

On a more positive note, no adverse effects were associated with taking DHEA long term, Dr. Nair said during a symposium at the meeting.

SANTA BARBARA, CALIF. — Prenatal alcohol exposure is most likely to affect children's attention problems when it occurs during the third trimester, a prospective study of 492 children determined.

There is a high degree of correlation between teacher- and parent-assessed attention deficits in children exposed to alcohol in late pregnancy, compared with alcohol exposure during the first or second trimesters, Beth Nordstrom Bailey, Ph.D., and her associates reported at the annual meeting of the Research Society on Alcoholism.

“These findings provide yet one more piece of evidence that the timing of prenatal alcohol exposure impacts child outcomes,” concluded the investigators, who presented their study in a poster.

The study from East Tennessee State University in Johnson City, where Dr. Bailey serves on the department of family medicine faculty, carries substantial weight because it prospectively tracked women's substance abuse throughout pregnancy and followed their children for 6–7 years.

The cohort was from urban Detroit and was mostly made up of African Americans with a low socioeconomic status, 90% of whom agreed to participate in the follow-up study.

Caregivers—most often the children's biological mothers—completed the Achenbach Child Behavior Checklist. Classroom teachers completed the Achenbach Teacher Report Form. Both standardized tools include Attention Problems scales.

In a logistic regression analysis, third-trimester prenatal alcohol exposure independently correlated with attention problems as assessed by both caregivers and teachers. Lead levels and custody changes also correlated with attention scores as assessed by parents and caregivers. Violence exposure factored into the equation only when teachers' assessments were considered. Prenatal exposure to cocaine, cigarettes, or alcohol during the first and second trimesters failed to independently correlate with later attention problems in children.

In an interview, Dr. Bailey explained that first-trimester exposures have the potential to affect global development of the fetus, possibly resulting in physical deformities, major cognitive impairment, and diminished growth.

In the third trimester, higher-order functions are most affected. “It's a time for fine-tuning in pregnancy,” she said. Alcohol exposure during this time appears to affect the specific attention and behavior functions that are readily assessed during the school-age years.

Environmental influences also contribute to such problems, but third-trimester alcohol exposure remains a strong correlate even after application of statistical controls for those factors.

“I think this study in particular makes it clear that it's never too late to quit,” Dr. Bailey said. “If at any point in pregnancy a woman can reduce her alcohol consumption or quit, there is still benefit.”

The Center for Healthcare Effectiveness Research at Wayne State University in Detroit contributed to the study, which was funded by the National Institutes of Health and the Children's Research Center of Michigan.

SANTA BARBARA, CALIF. — Prenatal alcohol exposure is most likely to affect children's attention problems when it occurs during the third trimester, a prospective study of 492 children determined.

There is a high degree of correlation between teacher- and parent-assessed attention deficits in children exposed to alcohol in late pregnancy, compared with alcohol exposure during the first or second trimesters, Beth Nordstrom Bailey, Ph.D., and her associates reported at the annual meeting of the Research Society on Alcoholism.

“These findings provide yet one more piece of evidence that the timing of prenatal alcohol exposure impacts child outcomes,” concluded the investigators, who presented their study in a poster.

The study from East Tennessee State University in Johnson City, where Dr. Bailey serves on the department of family medicine faculty, carries substantial weight because it prospectively tracked women's substance abuse throughout pregnancy and followed their children for 6–7 years.

The cohort was from urban Detroit and was mostly made up of African Americans with a low socioeconomic status, 90% of whom agreed to participate in the follow-up study.

Caregivers—most often the children's biological mothers—completed the Achenbach Child Behavior Checklist. Classroom teachers completed the Achenbach Teacher Report Form. Both standardized tools include Attention Problems scales.

In a logistic regression analysis, third-trimester prenatal alcohol exposure independently correlated with attention problems as assessed by both caregivers and teachers. Lead levels and custody changes also correlated with attention scores as assessed by parents and caregivers. Violence exposure factored into the equation only when teachers' assessments were considered. Prenatal exposure to cocaine, cigarettes, or alcohol during the first and second trimesters failed to independently correlate with later attention problems in children.

In an interview, Dr. Bailey explained that first-trimester exposures have the potential to affect global development of the fetus, possibly resulting in physical deformities, major cognitive impairment, and diminished growth.

In the third trimester, higher-order functions are most affected. “It's a time for fine-tuning in pregnancy,” she said. Alcohol exposure during this time appears to affect the specific attention and behavior functions that are readily assessed during the school-age years.

Environmental influences also contribute to such problems, but third-trimester alcohol exposure remains a strong correlate even after application of statistical controls for those factors.

“I think this study in particular makes it clear that it's never too late to quit,” Dr. Bailey said. “If at any point in pregnancy a woman can reduce her alcohol consumption or quit, there is still benefit.”

The Center for Healthcare Effectiveness Research at Wayne State University in Detroit contributed to the study, which was funded by the National Institutes of Health and the Children's Research Center of Michigan.

SANTA BARBARA, CALIF. — Prenatal alcohol exposure is most likely to affect children's attention problems when it occurs during the third trimester, a prospective study of 492 children determined.

There is a high degree of correlation between teacher- and parent-assessed attention deficits in children exposed to alcohol in late pregnancy, compared with alcohol exposure during the first or second trimesters, Beth Nordstrom Bailey, Ph.D., and her associates reported at the annual meeting of the Research Society on Alcoholism.

“These findings provide yet one more piece of evidence that the timing of prenatal alcohol exposure impacts child outcomes,” concluded the investigators, who presented their study in a poster.

The study from East Tennessee State University in Johnson City, where Dr. Bailey serves on the department of family medicine faculty, carries substantial weight because it prospectively tracked women's substance abuse throughout pregnancy and followed their children for 6–7 years.

The cohort was from urban Detroit and was mostly made up of African Americans with a low socioeconomic status, 90% of whom agreed to participate in the follow-up study.

Caregivers—most often the children's biological mothers—completed the Achenbach Child Behavior Checklist. Classroom teachers completed the Achenbach Teacher Report Form. Both standardized tools include Attention Problems scales.

In a logistic regression analysis, third-trimester prenatal alcohol exposure independently correlated with attention problems as assessed by both caregivers and teachers. Lead levels and custody changes also correlated with attention scores as assessed by parents and caregivers. Violence exposure factored into the equation only when teachers' assessments were considered. Prenatal exposure to cocaine, cigarettes, or alcohol during the first and second trimesters failed to independently correlate with later attention problems in children.

In an interview, Dr. Bailey explained that first-trimester exposures have the potential to affect global development of the fetus, possibly resulting in physical deformities, major cognitive impairment, and diminished growth.

In the third trimester, higher-order functions are most affected. “It's a time for fine-tuning in pregnancy,” she said. Alcohol exposure during this time appears to affect the specific attention and behavior functions that are readily assessed during the school-age years.

Environmental influences also contribute to such problems, but third-trimester alcohol exposure remains a strong correlate even after application of statistical controls for those factors.

“I think this study in particular makes it clear that it's never too late to quit,” Dr. Bailey said. “If at any point in pregnancy a woman can reduce her alcohol consumption or quit, there is still benefit.”

The Center for Healthcare Effectiveness Research at Wayne State University in Detroit contributed to the study, which was funded by the National Institutes of Health and the Children's Research Center of Michigan.

SANTA BARBARA, CALIF. — The psychiatric and behavioral consequences of heavy prenatal alcohol exposure on children are abundantly clear by midchildhood and adolescence, according to studies presented at the annual meeting of the Research Society on Alcoholism.

One study found that children exposed prenatally to alcohol were far more likely than their peers to meet the diagnostic criteria for attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder, conduct disorder, tic disorders, and mood disorders by the time they were 8–14 years old.

Another study assessed social problem-solving skills and executive functioning in adolescents who were heavily exposed to alcohol in utero. Profound impairments were found in both types of skills, which are integral to academic achievement and social interaction. The studies were conducted by researchers from the Center for Behavioral Teratology at San Diego State University, and were presented in poster form.

Sarah N. Mattson, Ph.D., a senior author on the studies, said in an interview that “heavy alcohol exposure” was equivalent to about a case of beer or a fifth of hard liquor a day.

Susanna L. Fryer, a doctoral student at the center, explored childhood psychopathologies in 43 alcohol-exposed and 22 nonexposed children using structured interviews with primary caregivers. “The difference within the ADHD category was, by far, the largest [group] effect observed,” she concluded.

By the numbers, 42 of 43 alcohol-exposed children met diagnostic criteria for ADHD, compared with 1 of 22 nonexposed children matched by age and socioeconomic status.

Nearly a third (13 of 43) of the alcohol-exposed children had oppositional defiant disorder, but just one nonexposed child met the criteria for that diagnosis. Mood disorders were found in eight alcohol-exposed children, tic disorders in four, and conduct disorder in five. No child in the control group met the diagnostic criteria for any of those illnesses.

“Certain psychiatric disorders may be more prevalent than others in fetal alcohol spectrum disorders; disruptive psychopathologies were particularly common in our sample, while anxiety disorders were not,” wrote Ms. Fryer. Similarly, children exposed to alcohol prenatally were no more likely than controls to have simple phobias.

Christie L. McGee, who is also a doctoral student at the center, reported on social problem-solving deficits in 43 adolescents aged 13–18 years, 24 of whom were prenatally exposed to heavy alcohol use. The adolescents completed the Revised Social Problem-Solving Inventory (SPSI-R), which measures an individual's ability to resolve the problems of everyday living. The teenagers' parents or caregivers completed the Behavior Rating Inventory of Executive Function (BRIEF), which includes subscales on such characteristics as a child's emotional control, working memory, and ability to plan and organize. Responses were anonymous.

Very large differences were found between the alcohol-exposed and nonexposed adolescents, with effect sizes ranging from 1.32 to 1.41 for problem solving skills and 1.96 to 4.61 for executive functioning.

Those exposed to alcohol in utero “approached problems with a pessimistic orientation and indicated a low frustration tolerance,” said Ms. McGee.

“[They] rated themselves as less effective at identifying problems, generating solutions, making decisions, and implementing and verifying the chosen solution … [and they were] more likely to endorse an avoidant, careless, or impulsive approach to solving their everyday problems,” she continued.

SANTA BARBARA, CALIF. — The psychiatric and behavioral consequences of heavy prenatal alcohol exposure on children are abundantly clear by midchildhood and adolescence, according to studies presented at the annual meeting of the Research Society on Alcoholism.

One study found that children exposed prenatally to alcohol were far more likely than their peers to meet the diagnostic criteria for attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder, conduct disorder, tic disorders, and mood disorders by the time they were 8–14 years old.

Another study assessed social problem-solving skills and executive functioning in adolescents who were heavily exposed to alcohol in utero. Profound impairments were found in both types of skills, which are integral to academic achievement and social interaction. The studies were conducted by researchers from the Center for Behavioral Teratology at San Diego State University, and were presented in poster form.

Sarah N. Mattson, Ph.D., a senior author on the studies, said in an interview that “heavy alcohol exposure” was equivalent to about a case of beer or a fifth of hard liquor a day.

Susanna L. Fryer, a doctoral student at the center, explored childhood psychopathologies in 43 alcohol-exposed and 22 nonexposed children using structured interviews with primary caregivers. “The difference within the ADHD category was, by far, the largest [group] effect observed,” she concluded.

By the numbers, 42 of 43 alcohol-exposed children met diagnostic criteria for ADHD, compared with 1 of 22 nonexposed children matched by age and socioeconomic status.

Nearly a third (13 of 43) of the alcohol-exposed children had oppositional defiant disorder, but just one nonexposed child met the criteria for that diagnosis. Mood disorders were found in eight alcohol-exposed children, tic disorders in four, and conduct disorder in five. No child in the control group met the diagnostic criteria for any of those illnesses.

“Certain psychiatric disorders may be more prevalent than others in fetal alcohol spectrum disorders; disruptive psychopathologies were particularly common in our sample, while anxiety disorders were not,” wrote Ms. Fryer. Similarly, children exposed to alcohol prenatally were no more likely than controls to have simple phobias.

Christie L. McGee, who is also a doctoral student at the center, reported on social problem-solving deficits in 43 adolescents aged 13–18 years, 24 of whom were prenatally exposed to heavy alcohol use. The adolescents completed the Revised Social Problem-Solving Inventory (SPSI-R), which measures an individual's ability to resolve the problems of everyday living. The teenagers' parents or caregivers completed the Behavior Rating Inventory of Executive Function (BRIEF), which includes subscales on such characteristics as a child's emotional control, working memory, and ability to plan and organize. Responses were anonymous.

Very large differences were found between the alcohol-exposed and nonexposed adolescents, with effect sizes ranging from 1.32 to 1.41 for problem solving skills and 1.96 to 4.61 for executive functioning.

Those exposed to alcohol in utero “approached problems with a pessimistic orientation and indicated a low frustration tolerance,” said Ms. McGee.

“[They] rated themselves as less effective at identifying problems, generating solutions, making decisions, and implementing and verifying the chosen solution … [and they were] more likely to endorse an avoidant, careless, or impulsive approach to solving their everyday problems,” she continued.

SANTA BARBARA, CALIF. — The psychiatric and behavioral consequences of heavy prenatal alcohol exposure on children are abundantly clear by midchildhood and adolescence, according to studies presented at the annual meeting of the Research Society on Alcoholism.

One study found that children exposed prenatally to alcohol were far more likely than their peers to meet the diagnostic criteria for attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder, conduct disorder, tic disorders, and mood disorders by the time they were 8–14 years old.

Another study assessed social problem-solving skills and executive functioning in adolescents who were heavily exposed to alcohol in utero. Profound impairments were found in both types of skills, which are integral to academic achievement and social interaction. The studies were conducted by researchers from the Center for Behavioral Teratology at San Diego State University, and were presented in poster form.

Sarah N. Mattson, Ph.D., a senior author on the studies, said in an interview that “heavy alcohol exposure” was equivalent to about a case of beer or a fifth of hard liquor a day.

Susanna L. Fryer, a doctoral student at the center, explored childhood psychopathologies in 43 alcohol-exposed and 22 nonexposed children using structured interviews with primary caregivers. “The difference within the ADHD category was, by far, the largest [group] effect observed,” she concluded.

By the numbers, 42 of 43 alcohol-exposed children met diagnostic criteria for ADHD, compared with 1 of 22 nonexposed children matched by age and socioeconomic status.

Nearly a third (13 of 43) of the alcohol-exposed children had oppositional defiant disorder, but just one nonexposed child met the criteria for that diagnosis. Mood disorders were found in eight alcohol-exposed children, tic disorders in four, and conduct disorder in five. No child in the control group met the diagnostic criteria for any of those illnesses.

“Certain psychiatric disorders may be more prevalent than others in fetal alcohol spectrum disorders; disruptive psychopathologies were particularly common in our sample, while anxiety disorders were not,” wrote Ms. Fryer. Similarly, children exposed to alcohol prenatally were no more likely than controls to have simple phobias.

Christie L. McGee, who is also a doctoral student at the center, reported on social problem-solving deficits in 43 adolescents aged 13–18 years, 24 of whom were prenatally exposed to heavy alcohol use. The adolescents completed the Revised Social Problem-Solving Inventory (SPSI-R), which measures an individual's ability to resolve the problems of everyday living. The teenagers' parents or caregivers completed the Behavior Rating Inventory of Executive Function (BRIEF), which includes subscales on such characteristics as a child's emotional control, working memory, and ability to plan and organize. Responses were anonymous.

Very large differences were found between the alcohol-exposed and nonexposed adolescents, with effect sizes ranging from 1.32 to 1.41 for problem solving skills and 1.96 to 4.61 for executive functioning.

Those exposed to alcohol in utero “approached problems with a pessimistic orientation and indicated a low frustration tolerance,” said Ms. McGee.

“[They] rated themselves as less effective at identifying problems, generating solutions, making decisions, and implementing and verifying the chosen solution … [and they were] more likely to endorse an avoidant, careless, or impulsive approach to solving their everyday problems,” she continued.

SANTA BARBARA, CALIF. – Smoking appears to heighten neuropsychological deficits found in heavy social drinkers, researchers reported at the annual meeting of the Research Society on Alcoholism.

Specifically, deficits in executive functioning and balance seen in people who both smoked and drank heavily were significantly worse than those seen in heavy-drinking nonsmokers, said Timothy C. Durazzo, Ph.D., a neuropsychologist and neuroscience researcher at the San Francisco Veterans Administration Medical Center.

“We believe smoking may compound alcohol-induced neurobiologic and neurocognitive dysfunction among individuals with alcohol use disorders,” said Dr. Durazzo following the meeting.

The neuropsychological results build on Dr. Durazzo's earlier identification–by MRI and magnetic resonance spectroscopy–of specific brain metabolite deficits in the frontal lobes and subcortical structures of smokers who had recently undergone alcohol detoxification (Alcohol. Clin. Exp. Res. 2004;28:1849–60).

The study concluded that smoking exacerbates alcohol-related frontal lobe neuronal injury and cell membrane damage, but also has an independent adverse effect on subcortical structures.

In the current study, Dr. Durazzo and associates administered neuropsychological tests to 33 socially functioning heavy drinkers, 13 of whom were also daily smokers, and 22 nonsmoking light drinkers.

Heavy drinking was defined as consuming more than 80 drinks per month, but study subjects actually consumed considerably more. Nonsmoking heavy drinkers averaged 141 lifetime drinks per month, while heavy drinkers who smoked drank an estimated 227 drinks per month.

Subjects were mostly in their early 40s with a relatively high level of education (14–15 years, on average). Most were males. No subject suffered a medical condition that could impair neurocognition.

Significant differences between smoking and nonsmoking heavy drinkers were detected on the Wisconsin Card Sorting Test (WCST), computerized version, reflecting executive function; and on the Fregly-Graybiel Ataxia Battery, reflecting balance.

Nonsmoking heavy drinkers, in fact, performed better than smoking heavy drinkers on every WCST measure except nonperseverative errors.

Perseverative response scores, for example, averaged 14.7 for nonsmoking heavy drinkers and 24.5 for heavy drinkers who smoked. As a point of comparison, the matched controls who neither smoked nor drank heavily had an average perseverative response score of 12.1.

Ataxia and balance-related scores showed significant differences as well.

Total raw scores on the Fregly-Graybiel Ataxia Battery and the Sharpened Romberg Test were 151.8 for nonsmoking heavy drinkers and 107.7 for smoking heavy drinkers. The nonsmoking light drinkers who served as controls scored significantly higher at 208.5.

By contrast, no significant differences were found in visuospatial memory and working memory among heavy drinkers who smoked, nonsmoking heavy drinkers, and controls.

Previous research has concluded that heavy drinking is associated with depleted cortical gray matter volume and diminished levels of N-acetylaspartate (a marker of neuronal viability) in the lower frontal white matter and gray matter, Dr. Durazzo said. Cigarette smoke contains many toxic compounds that may have an added negative effect on brain structure and function, particularly the cortical gray matter and the frontal lobes–“critical components of functional circuits mediating executive and motor functions,” he explained in a poster presented at the meeting.

More study is needed to determine the relative contributions of heavy drinking and smoking to changes in the brain and resulting neuropsychological function deficits, he said.

SANTA BARBARA, CALIF. – Smoking appears to heighten neuropsychological deficits found in heavy social drinkers, researchers reported at the annual meeting of the Research Society on Alcoholism.

Specifically, deficits in executive functioning and balance seen in people who both smoked and drank heavily were significantly worse than those seen in heavy-drinking nonsmokers, said Timothy C. Durazzo, Ph.D., a neuropsychologist and neuroscience researcher at the San Francisco Veterans Administration Medical Center.

“We believe smoking may compound alcohol-induced neurobiologic and neurocognitive dysfunction among individuals with alcohol use disorders,” said Dr. Durazzo following the meeting.

The neuropsychological results build on Dr. Durazzo's earlier identification–by MRI and magnetic resonance spectroscopy–of specific brain metabolite deficits in the frontal lobes and subcortical structures of smokers who had recently undergone alcohol detoxification (Alcohol. Clin. Exp. Res. 2004;28:1849–60).

The study concluded that smoking exacerbates alcohol-related frontal lobe neuronal injury and cell membrane damage, but also has an independent adverse effect on subcortical structures.

In the current study, Dr. Durazzo and associates administered neuropsychological tests to 33 socially functioning heavy drinkers, 13 of whom were also daily smokers, and 22 nonsmoking light drinkers.

Heavy drinking was defined as consuming more than 80 drinks per month, but study subjects actually consumed considerably more. Nonsmoking heavy drinkers averaged 141 lifetime drinks per month, while heavy drinkers who smoked drank an estimated 227 drinks per month.

Subjects were mostly in their early 40s with a relatively high level of education (14–15 years, on average). Most were males. No subject suffered a medical condition that could impair neurocognition.

Significant differences between smoking and nonsmoking heavy drinkers were detected on the Wisconsin Card Sorting Test (WCST), computerized version, reflecting executive function; and on the Fregly-Graybiel Ataxia Battery, reflecting balance.

Nonsmoking heavy drinkers, in fact, performed better than smoking heavy drinkers on every WCST measure except nonperseverative errors.

Perseverative response scores, for example, averaged 14.7 for nonsmoking heavy drinkers and 24.5 for heavy drinkers who smoked. As a point of comparison, the matched controls who neither smoked nor drank heavily had an average perseverative response score of 12.1.

Ataxia and balance-related scores showed significant differences as well.

Total raw scores on the Fregly-Graybiel Ataxia Battery and the Sharpened Romberg Test were 151.8 for nonsmoking heavy drinkers and 107.7 for smoking heavy drinkers. The nonsmoking light drinkers who served as controls scored significantly higher at 208.5.

By contrast, no significant differences were found in visuospatial memory and working memory among heavy drinkers who smoked, nonsmoking heavy drinkers, and controls.

Previous research has concluded that heavy drinking is associated with depleted cortical gray matter volume and diminished levels of N-acetylaspartate (a marker of neuronal viability) in the lower frontal white matter and gray matter, Dr. Durazzo said. Cigarette smoke contains many toxic compounds that may have an added negative effect on brain structure and function, particularly the cortical gray matter and the frontal lobes–“critical components of functional circuits mediating executive and motor functions,” he explained in a poster presented at the meeting.

More study is needed to determine the relative contributions of heavy drinking and smoking to changes in the brain and resulting neuropsychological function deficits, he said.

SANTA BARBARA, CALIF. – Smoking appears to heighten neuropsychological deficits found in heavy social drinkers, researchers reported at the annual meeting of the Research Society on Alcoholism.

Specifically, deficits in executive functioning and balance seen in people who both smoked and drank heavily were significantly worse than those seen in heavy-drinking nonsmokers, said Timothy C. Durazzo, Ph.D., a neuropsychologist and neuroscience researcher at the San Francisco Veterans Administration Medical Center.

“We believe smoking may compound alcohol-induced neurobiologic and neurocognitive dysfunction among individuals with alcohol use disorders,” said Dr. Durazzo following the meeting.

The neuropsychological results build on Dr. Durazzo's earlier identification–by MRI and magnetic resonance spectroscopy–of specific brain metabolite deficits in the frontal lobes and subcortical structures of smokers who had recently undergone alcohol detoxification (Alcohol. Clin. Exp. Res. 2004;28:1849–60).

The study concluded that smoking exacerbates alcohol-related frontal lobe neuronal injury and cell membrane damage, but also has an independent adverse effect on subcortical structures.

In the current study, Dr. Durazzo and associates administered neuropsychological tests to 33 socially functioning heavy drinkers, 13 of whom were also daily smokers, and 22 nonsmoking light drinkers.

Heavy drinking was defined as consuming more than 80 drinks per month, but study subjects actually consumed considerably more. Nonsmoking heavy drinkers averaged 141 lifetime drinks per month, while heavy drinkers who smoked drank an estimated 227 drinks per month.

Subjects were mostly in their early 40s with a relatively high level of education (14–15 years, on average). Most were males. No subject suffered a medical condition that could impair neurocognition.

Significant differences between smoking and nonsmoking heavy drinkers were detected on the Wisconsin Card Sorting Test (WCST), computerized version, reflecting executive function; and on the Fregly-Graybiel Ataxia Battery, reflecting balance.

Nonsmoking heavy drinkers, in fact, performed better than smoking heavy drinkers on every WCST measure except nonperseverative errors.

Perseverative response scores, for example, averaged 14.7 for nonsmoking heavy drinkers and 24.5 for heavy drinkers who smoked. As a point of comparison, the matched controls who neither smoked nor drank heavily had an average perseverative response score of 12.1.

Ataxia and balance-related scores showed significant differences as well.

Total raw scores on the Fregly-Graybiel Ataxia Battery and the Sharpened Romberg Test were 151.8 for nonsmoking heavy drinkers and 107.7 for smoking heavy drinkers. The nonsmoking light drinkers who served as controls scored significantly higher at 208.5.

By contrast, no significant differences were found in visuospatial memory and working memory among heavy drinkers who smoked, nonsmoking heavy drinkers, and controls.

Previous research has concluded that heavy drinking is associated with depleted cortical gray matter volume and diminished levels of N-acetylaspartate (a marker of neuronal viability) in the lower frontal white matter and gray matter, Dr. Durazzo said. Cigarette smoke contains many toxic compounds that may have an added negative effect on brain structure and function, particularly the cortical gray matter and the frontal lobes–“critical components of functional circuits mediating executive and motor functions,” he explained in a poster presented at the meeting.

More study is needed to determine the relative contributions of heavy drinking and smoking to changes in the brain and resulting neuropsychological function deficits, he said.